But the Hillsborough County mom couldn't find a dentist who would accept Medicaid. At last, she found Suncoast Community Health Centers, where dentists administered anesthesia and pulled the tooth — in 15 minutes, said Dr. Richard Gyles, Suncoast's pediatric dental director.

Gyles said the case illustrates the reason Suncoast teamed up with a New York medical center to create the Tampa Bay area's first pediatric dental residency program: Too many children on Medicaid can't find a dentist.

The partnership, which began this summer, placed four postdoctoral dental residents from Lutheran Medical Center at Suncoast's medical clinic in Palm River as part of a two-year training program in pediatric care.

Lutheran has for decades sent its residents to underserved areas. Suncoast has provided medical and dental care for nearly 35 years but struggled to meet the high demand for dentistry, especially the specialized care that goes beyond basic cleanings.

"We just got sick and tired of not being able to find a home for these kids," said Suncoast executive director Bradley Herremans.

• • •

Florida's dental care crisis is a long-standing problem, earning the state a failing grade from a national foundation that looks at how well states provide dental care for children. Less than 15 percent of dentists accept Medicaid, the federal insurance program for the poor, notorious for its low reimbursement rates and high paperwork. In 2011, less than a quarter of Florida's children on Medicaid saw a dentist.

Last year, Florida shifted all Medicaid dental patients into managed care, a move that state officials said would save money so dentists could get better rates. But that hasn't happened so far, said Dr. Richard Stevenson, president of the Florida Dental Association.

One managed care company actually cut rates, and dentists who accept Medicaid have found themselves awash in new credential requirements, he said. "The networks (of participating dentists) are going to be severely challenged, if not damaged," Stevenson said.

• • •

Suncoast decided the situation was too dire to wait and see if it would improve through managed care. Herremans said the severity of the problem hit him four years ago when he was working at a dental care booth at the Plant City Strawberry Festival's health fair. A dentist was on hand with a device that showed kids the places they missed when they brushed their teeth.

It was supposed to be a fun opportunity to teach proper brushing techniques. But it quickly turned into a grim education for Herremans.

Eight of every 10 children who wandered up had decay and other serious dental problems. The dentist even found a dangerous abscess in one girl's mouth and urged her mother to take her straight to an emergency room.

"That's when the light went off," he said.

The residency program quickly came together after Suncoast's dental director, Dr. Randy Valdez, met a Lutheran representative at a conference last year.

Lutheran pays the four residents, who are also required to do rotations at Tampa General Hospital and South Florida Baptist Hospital as part of their training. Postdoctoral residents have the education to practice general dentistry but participate in additional training programs for specialized certifications, such as pediatrics, said Gyles, the Suncoast pediatric dental director.

The new Hillsborough pediatric program is one of only a handful in Florida. The University of Florida runs two similar residency programs in Gainesville and Naples, according to the American Academy of Pediatric Dentistry. Nova Southeastern University in Fort Lauderdale and Miami Children's Hospital also have two-year postdoctoral residency programs.

• • •

On Thursday afternoons, the four residents retreat to a room in the clinic where they participate in live lectures delivered to Lutheran's dozen residency sites around the nation via video conference.

One of the residents is Dr. Steven Tan, a 28-year-old California native who did his undergraduate work at Yale University and graduated dental school at Nova Southeastern. Now living in Brandon, he said he could have done his residency in a university setting but prefers the experience he is gaining.

"At a community health center, you get more clinical experience, and at the end of the day, that is what you want," Tan said.

Lutheran plans to send another four residents next year to join the current four in the two-year program. By then, Suncoast hopes to have opened a new center in Brandon that would have nearly twice the space for pediatric dental services. Herremans said the current pediatric clinic will be converted to an adult dental clinic.

Just after lunch on a recent day, the Palm River waiting room was jammed with children leaning into their parents or, for a few, slipping from their grips.

Shelley Reece of Brandon brought her 7-year-old grandniece, Kailey Clark. Kailey needed two teeth pulled that day and would return to get two more pulled.

The girl had made her first dental visit a week earlier when a dentist discovered severe decay. Reece, who recently took custody of Kailey, said she couldn't find a dentist who accepted Medicaid until someone told her about Suncoast. "This is about the only place I think takes it," she said.

She looked around at the sophisticated equipment, wall murals and flat-screen televisions showing cartoons for the young patients. "It's nice," she said.

Number of 2012 emergency room visits for preventable dental complaints by adults and children:

Hernando

1,108

Hillsborough

8,055

Pasco

3,924

Pinellas

6,061

Source: Florida Public Health Institute

.FAST FACTS

Get dental care

Hillsborough County residents can call (813) 653-6100 for an appointment at Suncoast Community Health Center. Looking for other dentists who see Medicaid patients or provide reduced-price care for the uninsured? Florida Dental Association has a county-by-county list of clinics you can try. For more information: http://bit.ly/1q1h9XK.